metaxalone (Rx)

Brand and Other Names:Skelaxin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 400mg
  • 800mg

Musculoskeletal Pain

Indicated for acute, painful musculoskeletal conditions

800 mg PO q6-8hr

Dosage Modifications

Renal impairment

  • Mild to moderate impairment: Use caution
  • Severe impairment: Contraindicated

Hepatic impairment

  • Mild to moderate impairment: Use caution
  • Severe impairment: Contraindicated

Systemic Sclerosis (Orphan)

Uvadex

In conjunction with the UVAR photopheresis to treat diffuse systemic sclerosis

Orphan indication sponsor

  • Therakos, Inc; Oaklands Corporate Center; 437 Creamery Way; Exton, PA 19341

Cardiac Allograft Rejection (Orphan)

Uvadex

Prevention of acute rejection of cardiac allografts

Orphan indication sponsor

  • Therakos, Inc; Oaklands Corporate Center; 437 Creamery Way; Exton, PA 19341

Dosage Forms and Strengths

tablet

  • 400mg
  • 800mg

Musculoskeletal Pain

<12 years: Safety and efficacy not established

≥12 years: 800 mg PO q6-8hr

Systemic Sclerosis (Orphan)

Uvadex

In conjunction with the UVAR photopheresis to treat diffuse systemic sclerosis

Orphan indication sponsor

  • Therakos, Inc; Oaklands Corporate Center; 437 Creamery Way; Exton, PA 19341

Cardiac Allograft Rejection (Orphan)

Uvadex

Prevention of acute rejection of cardiac allografts

Orphan indication sponsor

  • Therakos, Inc; Oaklands Corporate Center; 437 Creamery Way; Exton, PA 19341
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Interactions

Interaction Checker

and metaxalone

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              Serious - Use Alternative (14)

              • abametapir

                abametapir will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

              • apalutamide

                apalutamide will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, metaxalone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • calcium/magnesium/potassium/sodium oxybates

                metaxalone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • fexinidazole

                fexinidazole will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

              • hydrocodone

                hydrocodone, metaxalone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • idelalisib

                idelalisib will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

              • ivosidenib

                ivosidenib will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

              • lopinavir

                lopinavir will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • metoclopramide intranasal

                metaxalone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • sodium oxybate

                metaxalone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • sufentanil SL

                sufentanil SL, metaxalone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tucatinib

                tucatinib will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

              • voxelotor

                voxelotor will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

              Monitor Closely (171)

              • abiraterone

                abiraterone increases levels of metaxalone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

              • abobotulinumtoxinA

                metaxalone increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • alfentanil

                metaxalone and alfentanil both increase sedation. Use Caution/Monitor.

              • alprazolam

                alprazolam and metaxalone both increase sedation. Use Caution/Monitor.

              • amitriptyline

                metaxalone and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                amobarbital and metaxalone both increase sedation. Use Caution/Monitor.

                amobarbital will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • amoxapine

                metaxalone and amoxapine both increase sedation. Use Caution/Monitor.

              • apomorphine

                metaxalone and apomorphine both increase sedation. Use Caution/Monitor.

              • aripiprazole

                metaxalone and aripiprazole both increase sedation. Use Caution/Monitor.

              • azelastine

                azelastine and metaxalone both increase sedation. Use Caution/Monitor.

              • baclofen

                baclofen and metaxalone both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                metaxalone and belladonna and opium both increase sedation. Use Caution/Monitor.

              • benperidol

                metaxalone and benperidol both increase sedation. Use Caution/Monitor.

              • benzphetamine

                metaxalone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • brexanolone

                brexanolone, metaxalone. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • brompheniramine

                brompheniramine and metaxalone both increase sedation. Use Caution/Monitor.

              • buprenorphine

                metaxalone and buprenorphine both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                metaxalone and buprenorphine buccal both increase sedation. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                buprenorphine, long-acting injection increases effects of metaxalone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and increase risk for respiratory depression. Monitor for signs of respiratory depression that may be greater than otherwise expected and decrease muscle relaxant dosage as necessary.

              • butabarbital

                butabarbital and metaxalone both increase sedation. Use Caution/Monitor.

              • butalbital

                butalbital and metaxalone both increase sedation. Use Caution/Monitor.

              • butorphanol

                metaxalone and butorphanol both increase sedation. Use Caution/Monitor.

              • cannabidiol

                cannabidiol, metaxalone. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

              • carbinoxamine

                carbinoxamine and metaxalone both increase sedation. Use Caution/Monitor.

              • carisoprodol

                carisoprodol and metaxalone both increase sedation. Use Caution/Monitor.

              • cenobamate

                cenobamate will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

              • chloral hydrate

                chloral hydrate and metaxalone both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide and metaxalone both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine and metaxalone both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                metaxalone and chlorpromazine both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                chlorzoxazone and metaxalone both increase sedation. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and metaxalone both increase sedation. Use Caution/Monitor.

              • clemastine

                clemastine and metaxalone both increase sedation. Use Caution/Monitor.

              • clobazam

                metaxalone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clomipramine

                metaxalone and clomipramine both increase sedation. Use Caution/Monitor.

              • clonazepam

                clonazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • clorazepate

                clorazepate and metaxalone both increase sedation. Use Caution/Monitor.

              • clozapine

                metaxalone and clozapine both increase sedation. Use Caution/Monitor.

              • codeine

                metaxalone and codeine both increase sedation. Use Caution/Monitor.

              • crofelemer

                crofelemer increases levels of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

              • cyclizine

                cyclizine and metaxalone both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                cyclobenzaprine and metaxalone both increase sedation. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and metaxalone both increase sedation. Use Caution/Monitor.

              • dabrafenib

                dabrafenib will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • dantrolene

                dantrolene and metaxalone both increase sedation. Use Caution/Monitor.

              • desipramine

                metaxalone and desipramine both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and metaxalone both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                metaxalone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                dexmedetomidine and metaxalone both increase sedation. Use Caution/Monitor.

              • dextromoramide

                metaxalone and dextromoramide both increase sedation. Use Caution/Monitor.

              • diamorphine

                metaxalone and diamorphine both increase sedation. Use Caution/Monitor.

              • diazepam

                diazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • diazepam intranasal

                diazepam intranasal, metaxalone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

              • difenoxin hcl

                metaxalone and difenoxin hcl both increase sedation. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate and metaxalone both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and metaxalone both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                metaxalone and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

              • dipipanone

                metaxalone and dipipanone both increase sedation. Use Caution/Monitor.

              • dopexamine

                metaxalone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                metaxalone and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                metaxalone and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                doxylamine and metaxalone both increase sedation. Use Caution/Monitor.

              • droperidol

                metaxalone and droperidol both increase sedation. Use Caution/Monitor.

              • efavirenz

                efavirenz will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • elagolix

                elagolix decreases levels of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of metaxalone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

              • encorafenib

                encorafenib, metaxalone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

              • esketamine intranasal

                esketamine intranasal, metaxalone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • estazolam

                estazolam and metaxalone both increase sedation. Use Caution/Monitor.

              • ethanol

                metaxalone and ethanol both increase sedation. Use Caution/Monitor.

              • etomidate

                etomidate and metaxalone both increase sedation. Use Caution/Monitor.

              • fedratinib

                fedratinib will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

              • fenfluramine

                metaxalone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fluphenazine

                metaxalone and fluphenazine both increase sedation. Use Caution/Monitor.

              • flurazepam

                flurazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • haloperidol

                metaxalone and haloperidol both increase sedation. Use Caution/Monitor.

              • hydromorphone

                metaxalone and hydromorphone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and metaxalone both increase sedation. Use Caution/Monitor.

              • iloperidone

                metaxalone and iloperidone both increase sedation. Use Caution/Monitor.

                iloperidone increases levels of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

              • imipramine

                metaxalone and imipramine both increase sedation. Use Caution/Monitor.

              • incobotulinumtoxinA

                metaxalone, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • istradefylline

                istradefylline will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              • ketamine

                ketamine and metaxalone both increase sedation. Use Caution/Monitor.

              • ketotifen, ophthalmic

                metaxalone and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • lasmiditan

                lasmiditan, metaxalone. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant, metaxalone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • levorphanol

                metaxalone and levorphanol both increase sedation. Use Caution/Monitor.

              • lofepramine

                metaxalone and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                metaxalone and lofexidine both increase sedation. Use Caution/Monitor.

              • loprazolam

                loprazolam and metaxalone both increase sedation. Use Caution/Monitor.

              • lorazepam

                lorazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • lorcaserin

                lorcaserin will increase the level or effect of metaxalone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • lormetazepam

                lormetazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • loxapine

                metaxalone and loxapine both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                metaxalone and loxapine inhaled both increase sedation. Use Caution/Monitor.

              • lurasidone

                lurasidone, metaxalone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                metaxalone and maprotiline both increase sedation. Use Caution/Monitor.

              • marijuana

                metaxalone and marijuana both increase sedation. Use Caution/Monitor.

              • melatonin

                metaxalone and melatonin both increase sedation. Use Caution/Monitor.

              • meperidine

                metaxalone and meperidine both increase sedation. Use Caution/Monitor.

              • meprobamate

                metaxalone and meprobamate both increase sedation. Use Caution/Monitor.

              • methadone

                metaxalone and methadone both increase sedation. Use Caution/Monitor.

              • methocarbamol

                metaxalone and methocarbamol both increase sedation. Use Caution/Monitor.

              • methylenedioxymethamphetamine

                metaxalone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • midazolam

                midazolam and metaxalone both increase sedation. Use Caution/Monitor.

              • midodrine

                metaxalone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mifepristone

                mifepristone will increase the level or effect of metaxalone by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9; use smallest recommended doses for substrates and monitor

              • mirabegron

                mirabegron will increase the level or effect of metaxalone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • mirtazapine

                metaxalone and mirtazapine both increase sedation. Use Caution/Monitor.

              • mitotane

                mitotane decreases levels of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

              • morphine

                metaxalone and morphine both increase sedation. Use Caution/Monitor.

              • motherwort

                metaxalone and motherwort both increase sedation. Use Caution/Monitor.

              • moxonidine

                metaxalone and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                metaxalone and nabilone both increase sedation. Use Caution/Monitor.

              • nalbuphine

                metaxalone and nalbuphine both increase sedation. Use Caution/Monitor.

              • nefazodone

                nefazodone will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nortriptyline

                metaxalone and nortriptyline both increase sedation. Use Caution/Monitor.

              • olanzapine

                metaxalone and olanzapine both increase sedation. Use Caution/Monitor.

              • oliceridine

                oliceridine, metaxalone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                metaxalone increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

              • opium tincture

                metaxalone and opium tincture both increase sedation. Use Caution/Monitor.

              • orphenadrine

                metaxalone and orphenadrine both increase sedation. Use Caution/Monitor.

              • oxazepam

                oxazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • oxycodone

                metaxalone and oxycodone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                metaxalone and oxymorphone both increase sedation. Use Caution/Monitor.

              • paliperidone

                metaxalone and paliperidone both increase sedation. Use Caution/Monitor.

              • papaveretum

                metaxalone and papaveretum both increase sedation. Use Caution/Monitor.

              • papaverine

                metaxalone and papaverine both increase sedation. Use Caution/Monitor.

              • pentazocine

                metaxalone and pentazocine both increase sedation. Use Caution/Monitor.

              • pentobarbital

                pentobarbital and metaxalone both increase sedation. Use Caution/Monitor.

              • perphenazine

                metaxalone and perphenazine both increase sedation. Use Caution/Monitor.

              • phenobarbital

                phenobarbital and metaxalone both increase sedation. Use Caution/Monitor.

              • phenylephrine PO

                metaxalone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • pholcodine

                metaxalone and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                metaxalone and pimozide both increase sedation. Use Caution/Monitor.

              • prabotulinumtoxinA

                metaxalone increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • primidone

                primidone and metaxalone both increase sedation. Use Caution/Monitor.

              • prochlorperazine

                metaxalone and prochlorperazine both increase sedation. Use Caution/Monitor.

              • promethazine

                promethazine and metaxalone both increase sedation. Use Caution/Monitor.

              • propofol

                propofol and metaxalone both increase sedation. Use Caution/Monitor.

              • propylhexedrine

                metaxalone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                metaxalone and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                quazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • quetiapine

                metaxalone and quetiapine both increase sedation. Use Caution/Monitor.

              • ramelteon

                metaxalone and ramelteon both increase sedation. Use Caution/Monitor.

              • remifentanil

                metaxalone increases effects of remifentanil by pharmacodynamic synergism. Modify Therapy/Monitor Closely. CNS depressant effect increased.

              • remimazolam

                remimazolam, metaxalone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

              • risperidone

                metaxalone and risperidone both increase sedation. Use Caution/Monitor.

              • rucaparib

                rucaparib will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

              • scullcap

                metaxalone and scullcap both increase sedation. Use Caution/Monitor.

              • secobarbital

                secobarbital and metaxalone both increase sedation. Use Caution/Monitor.

              • shepherd's purse

                metaxalone and shepherd's purse both increase sedation. Use Caution/Monitor.

              • stiripentol

                stiripentol, metaxalone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

                stiripentol, metaxalone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                metaxalone and sufentanil both increase sedation. Use Caution/Monitor.

              • tapentadol

                metaxalone and tapentadol both increase sedation. Use Caution/Monitor.

              • tazemetostat

                tazemetostat will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tecovirimat

                tecovirimat will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

              • temazepam

                temazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • teriflunomide

                teriflunomide increases levels of metaxalone by Other (see comment). Use Caution/Monitor. Comment: Teriflunomide inhibits CYP2C8; caution when coadministered with CYP2C8 substrates.

                teriflunomide decreases levels of metaxalone by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • thioridazine

                metaxalone and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                metaxalone and thiothixene both increase sedation. Use Caution/Monitor.

              • topiramate

                metaxalone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                metaxalone and tramadol both increase sedation. Use Caution/Monitor.

              • trazodone

                metaxalone and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                triazolam and metaxalone both increase sedation. Use Caution/Monitor.

              • triclofos

                triclofos and metaxalone both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                metaxalone and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trimipramine

                metaxalone and trimipramine both increase sedation. Use Caution/Monitor.

              • xylometazoline

                metaxalone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziconotide

                metaxalone and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                metaxalone and ziprasidone both increase sedation. Use Caution/Monitor.

              • zotepine

                metaxalone and zotepine both increase sedation. Use Caution/Monitor.

              Minor (3)

              • eucalyptus

                metaxalone and eucalyptus both increase sedation. Minor/Significance Unknown.

              • ribociclib

                ribociclib will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sage

                metaxalone and sage both increase sedation. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Drug-induced gastrointestinal disturbance

              Nausea

              Vomiting

              Dizziness

              Headache

              Somnolence

              Nervousness

              Hemolytic anemia (rare)

              Leukopenia (rare)

              Jaundice (rare)

              Immune hypersensitivity reaction (rare)

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              Warnings

              Contraindications

              Hypersensitivity

              History of drug-induced hemolytic anemia

              Significant renal/hepatic impairment

              Cautions

              CNS depression may occur

              Sedative effects may be potentiated when used with other sedatives

              Medication is poorly tolerated by the elderly

              Bioavailability may increase in female patients

              Use caution in renal and hepatic impairment

              Safety and efficacy not established in children <12 years

              May impair physical or mental abilities; caution patient against operating heavy machinery or performing taks requiring mental alertness

              Cases of serotonin syndrome, a potentially life-threatening condition, reported during concomitant use of serotonergic drugs with dose within recommended range and with a single agent taken at doses higher than recommended dose; onset of symptoms generally occurs within several hours to a few days, but may occur later than that; discontinue therapy if serotonin syndrome suspected

              Sedative effects of and other CNS depressants (eg, alcohol, benzodiazepines, opioids, tricyclic antidepressants (TCAs)) may be additive; exercise caution with patients who take more than one of CNS depressants simultaneously; follow patients closely for signs and symptoms of respiratory depression and sedation

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              Pregnancy & Lactation

              Pregnancy category: C

              Lactation: Unknown if excreted in breast milk; not recommended

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              General CNS depression; no direct effect on skeletal muscle; may disrupt the spasm-pain-spasm cycle; does not havae direct effect on skeletal muscle

              Absorption

              Onset: Within 1 hr

              Duration: 4-6 hr

              Peak plasma time: 3 hr

              Peak plasma concentration: 296 mcg/mL

              Distribution

              Vd: 800 L

              Metabolism

              Liver

              Metabolites: Unidentified

              Elimination

              Half-life elimination: 4-14 hr

              Excretion: Urine

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Skelaxin oral
              -
              800 mg tablet
              Skelaxin oral
              -
              800 mg tablet
              Skelaxin oral
              -
              800 mg tablet
              metaxalone oral
              -
              800 mg tablet
              metaxalone oral
              -
              800 mg tablet
              metaxalone oral
              -
              800 mg tablet
              metaxalone oral
              -
              800 mg tablet
              metaxalone oral
              -
              400 mg tablet
              metaxalone oral
              -
              800 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              metaxalone oral

              METAXALONE - ORAL

              (me-TAX-a-lone)

              COMMON BRAND NAME(S): Skelaxin

              USES: Metaxalone is used to treat muscle spasms/pain. It is usually used along with rest, physical therapy, and other treatment.

              HOW TO USE: Take this medication by mouth with or without food as directed by your doctor. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. If you take this medication after a high-fat meal and experience side effects, it may be best to take this drug on an empty stomach or after a light meal.The dosage is based on your medical condition and response to treatment.To prevent a very serious high blood pressure reaction, it is very important that you follow a special diet recommended by your doctor or dietician to limit your intake of tyramine while you are taking this medicine. Avoid foods and beverages that are high in tyramine, including aged cheeses, dried/aged meats and sausages (such as salami, liverwurst), preserved fish (such as pickled herring), products that contain large amounts of yeast (such as bouillon cubes, powdered soup/gravy, homemade or sourdough bread), fermented foods (such as sauerkraut, kim chee), most soybean products (such as soy sauce, tofu), broad/fava beans, red wine, sherry, tap beers, and vermouth. Consult your doctor or dietician for more details and a complete list of other foods that contain tyramine which you should limit or avoid.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: Drowsiness, dizziness, nausea, vomiting, and upset stomach may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as nervousness, irritability, confusion), signs of infection (such as fever, persistent sore throat), yellowing eyes/skin, unusual tiredness, dark urine.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (see How to Use and Drug Interactions sections). Get medical help right away if any of these serious side effects occur: severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, vision changes (such as double/blurred vision), sudden sensitivity to light (photophobia).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking metaxalone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, anemia, seizures.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially dizziness, drowsiness, or confusion. These side effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: diet pills/appetite suppressants (such as diethylpropion), drugs for attention deficit disorder (such as atomoxetine, methylphenidate), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, deutetrabenazine, a certain combination product (dextromethorphan/quinidine), levodopa, maprotiline, methyldopa, metoclopramide, certain opioid pain relievers (such as fentanyl, meperidine, methadone, tapentadol), certain drugs for Parkinson's disease (such as entacapone, tolcapone), certain supplements (such as tryptophan, tyramine), tetrabenazine, tricyclic antidepressants (such as amitriptyline, doxepin), valbenazine.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including mirtazapine, SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tramadol, certain "triptans" used to treat migraine headaches (such as rizatriptan, sumatriptan, zolmitriptan), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Some products can interact with metaxalone if you take them together, or even if you take them weeks before or after taking metaxalone. Tell your doctor or pharmacist if you take anything in the list of products that may interact with this drug, or any of the products that increase serotonin, within 2 weeks before or after taking metaxalone. Also tell them if you have taken fluoxetine within 5 weeks before starting metaxalone. Ask your doctor how much time to wait between starting or stopping any of these drugs and starting metaxalone.Taking other MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any other MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.Before using metaxalone, report the use of drugs that may increase the risk of extremely high blood pressure (hypertensive crisis) when combined with metaxalone, including herbal products (such as ephedra/ma huang), nasal decongestants (such as phenylephrine, pseudoephedrine), and stimulants (such as amphetamines, ephedrine, epinephrine, phenylalanine). Metaxalone should not be used with any of these medications. Talk to your doctor or pharmacist for more details.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), other muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.This medication may interfere with certain laboratory tests (including certain urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness.

              NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another condition unless your doctor directs you to do so. A different medication may be necessary in that case.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.